Rheumatoid arthritis, or RA, is a chronic autoimmune disease marked by inflammation of the lining of the joints. It causes painful swelling and stiffness of the joints, which may result in permanent damage and long term disability. Although the joints are the primary target of the illness, other body systems can also be affected, including the eyes, heart and lungs. Several different classes of medicines are used to control the pain and joint destruction associated with RA.
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDS) were once the first choice of treatment for RA. The National Institute of Arthritis and Musculoskeletal Diseases reports that the use of more potent drugs is now the preferred treatment for early stage disease. However, for mild disease or when other drugs are not tolerated, NSAIDs can be used to treat pain and inflammation.
Over-the-counter NSAIDs include aspirin and ibuprofen. These drugs work by blocking the production of inflammatory substances called prostaglandins.
The cox-2 inhibitor Celebrex is available as a prescription medication for the pain and inflammation of RA. This drug works like other NSAIDs but is gentler on the stomach and intestinal lining.
Corticosteroids
The steroids prednisone and methylprednisolone are used to ease pain, swelling and inflammation. These drugs are sometimes used in combination with other medications and are then tapered when the other medications take effect. Steroids suppress the immune system. They are generally for short term use due to potential toxicity.
Disease Modifying Anti-rheumatic Drugs
A class of drugs known as DMARDs is used to influence the underlying process of RA. These medications usually control pain, swelling and inflammation, and can prevent damage to the joints.
Methotrexate is the most commonly prescribed of the DMARD medications, according to the University of Maryland Medical Center. It may take four to six weeks to achieve the full benefit of the drug. Methotrexate is fairly well tolerated but can have serious negative effects, including liver and lung damage. The Johns Hopkins Arthritis Center states that many side effects can be reduced with folic acid supplementation.
Chloroquine, and hydroxychloroquine are anti-malarial drugs used either alone or in combination with methotrexate, and other DMARDs. These drugs potentially can be damaging to the eyes.
Sulfasalazine is another DMARD that is often combined with other drugs, such as methotrexate and hydroxychloroquin. The most common side effect is gastrointestinal upset.
Biologic Response Modifiers
Biologic response modifiers are the next choice of treatment if DMARD therapy fails, or some of them may be used in combination with DMARDs. These agents can work quickly to reduce pain and inflammation and help prevent destruction of the joints. They are all given by injection or intravenously.
Tumor necrosis factor, or TNF, is an inflammatory substance made by the body. The drugs infliximab, and etanercept are two of the most commonly prescribed agents used to block TNF. These TNF inhibitors are usually very effective in reducing the pain and swelling of RA. They can also slow or eliminate destruction of the joints.
Interleukin-1 inhibitors block the action of inflammatory substances in the body and are given by daily injection. The most often reported side effect is itching and redness at the injection site.
Rituximab is what is known as a monoclonal antibody. It attaches to and destroys B cells, which helps to reduce inflammation in the body. It may take up to three months to see benefit from this drug. People may experience fever, chills, itching and difficulty breathing with infusions of Rituximab, especially the first one.
About this Author
Kalli Harrison is a naturopathic physician living in Portland, Ore. She graduated from National College of Naturopathic Medicine in the year 2000, and also holds a degree as a medical laboratory technician. Dr. Harrison has been writing health and medical information for patients and clients for over ten years.
